In this episode, we’re pleased to welcome back Olga Barone-Allan to give us a glimpse into the upcoming BESLER webinar: The Importance of Data Analytics in Improving Your KPIs on Thursday, May 25, at 1 PM ET.
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Highlights of this episode include:
- Why are data analytics important for a hospital’s revenue cycle?
- Why technology is important
- Key KPIs to track
- Aged Trial Balance (ATB) still important?
Kelly Wisness: Hi, this is Kelly Wisness. Welcome back to the award-winning Hospital Finance Podcast.We’re pleased to welcome back Olga Barone-Allan. In this episode, Olga will give us a glimpse into the upcoming BESLER webinar, The Importance of Data Analytics in Improving Your KPIs, that we are hosting on Thursday, May 25th at 1 PM Eastern Time. Thank you for joining us today, Olga.
Olga Barone-Allan: Thank you, Kelly.
Kelly: All right, well, let’s jump in. So why are data analytics important for a hospital’s revenue cycle?
Olga: To understand data analytics, we must understand the revenue cycle process with an emphasis on integrity and the key performance indicators to get a full understanding. The healthcare revenue cycle integrity process is the financial oversight of management and patient services from scheduling until payment. So, the only way to achieve an efficient process is with the collaboration and support of administrative business and clinical departments. The involvement of the information technology department is also very critical to streamline tasks into automated algorithm within the department’s information system, making the flow efficient. Conceptually, this is very simple. However, it is a struggle to keep up with the constant regulatory changes, budgetary restrictions, departmental disconnects, as well as system limitations while juggling financial viability and delivering quality care.
Kelly: Thank you. And so what are the different stop points in a revenue cycle where data analytics need to be collected and monitored?
Olga: That’s a great question. There are so many. So, if we start from the beginning, it is pretty much pre-registration, the registration process. Then, it’s the utilization review, the charge capture, encoding, claim generation, and build drop. We have the payment posting, credit balances, and refund processing, AR follow-up in denial management, patient billing and collection and reporting, and those are just a few. And there’s so many more, but those are the really strong points of a revenue cycle that need to be captured in collecting the data for analytics.
Kelly: That makes sense. And so why is technology important?
Olga: So, as you can see, there are so many different areas and because of the life cycle of a bill, although it’s a quick cycle, but it could become very long. So, the longer the account stays on the receivables, the longer it increases your cost to collect. And the age of the account, it gets more difficult to collect that and those monies. So, technology is essential to track the key factors throughout the building cycle. Collecting payment and addressing claim denials are some of the few areas that you really want to get information to learn from. Some providers invest a lot of time and money on dashboards and common problems and work cues and workflows and specific billing processes because you have your observation billed differently, your same-day surgeries. There’s cardiac. There’s a lot of attention placed on those areas. So, providers continue to struggle with increased performance and limited resources. They must strive for efficient, effective workflows. Greater collaboration and communication between the clinical and administrative areas can increase a higher quality of reimbursement delivery, enhance patient communication and quality of care. The goal of the healthcare revenue cycle integrity is to develop a process that helps the organization get paid fully for services as quickly as possible.
Healthcare professionals should monitor claims processes closely to pinpoint errors. Revenue may potentially be lost if providers cannot identify where the issues originate and resolve those errors quickly. Most business offices have the inability to create or flag claims based on certain types of services, some examples, as I mentioned, observation midnight rule, same-day surgery, add on, pass-throughs, shadow billing. It is worth spending time with all the departments involved to identify, accurately update, and create UB-O4 to capture these specialized services. Having KPIs can help manage all these key points. So, data mining is an exceptional tool to trend and compare statistics over periods of time and going forward. Using these methods allows providers to react faster to inefficiency and revenue cycle integrity practices. The best approach is not to limit the data from one system, however, to collect data from registration mainframe billing follow-up system and analyze as a complete picture. Analyzing the data regularly also provides a benchmark to help executives to understand the true cost to collect by making decisions on increasing or decreasing technology, staff, or outsourcing services. Depending on whether one is assessing the entire process or on department or on the specific payer, there are different ratios available out there in the industry. So generally, the cost to collect increases over the life of a claim. The longer the claim remains on the receivable, the more difficult and more time-consuming it is to collect. Appropriate automation of businesses processes is key in helping in this area. The cleaner the claims, the fewer resources are needed and less likely the bill will age.
Kelly: That makes a lot of sense. What are some of the KPIs to track?
Olga: So, there are so many out there that are available. Some to mention, and then we’ll go further into them during the webinar or the point-of-sale policies that are available: percentage of AR over a year, late chart hold period, final bill claim not submitted, credit balance, AR, the billing turnaround, your percentage of clean claim submission, secondary and tertiary payer billing, your Medicare return to provider is very important to track your payer turnaround you know, electronic versus paper, and then tracking your denials by soft denials, hard denials, preventable denials, clinical denial, technical denials. And then there are some claim rejection turnarounds to learn from a denial overturn ratio, overpayment overturn ratio, and cost to collect. So those are just to name a few to start with, and there are a lot. And it’s not easy to establish them to know where to pull this from and then constantly maintain those numbers on a regular basis to monitor and manage. But they are so important, and you learn so much from managing and collecting that data.
Kelly: Wow, that’s a lot of KPIs you just kind of rattled off there. And I know there’s even more. So is the aged trial balance still a useful tool?
Olga: Aged trial balance is so important because looking at an aged trial balance allows you to take a look at accounts that are at risk, where your weak points are within your receivable. Depending on the age of your payer, based off of your financial class, you can see what age range are those that mostly need attention from your staff. The most common use of the ATB is to identify and prevent timely filing by payer because each payer has a timely filing limit. And the age just gives you a quick snapshot of any bottle necks that are in your receivable that you can dig into to determine and identify the root cause of issues that you may not be aware of. So, it is extremely important to use an ATB and it’s still a very useful tool.
Kelly: It sounds like it. How can data analytics help KPIs?
Olga: So, data analytics allows one to really understand how they are not meeting or are meeting their KPIs. Without data analytics and the ability to understand all critical pieces of data available, it’s almost impossible to correct shortfalls and hit the mark. Data analytics is the collection, translation, and interpretation of data to draw conclusions, make prediction and drive informed decision-making. Real-time monitoring is imperative to one’s ability to make an informed business decision at any point in time. Although time-consuming in maintaining the data analytics feed into the KPIs, the output is important because it helps businesses optimize their performances, reduce costs, and make better business decisions. Data analytics plays a crucial role in identifying, measuring, and improving KPIs. KPIs are measurable metrics that organizations use to track their progress towards achieving specific business goals. They provide insight into the performance of various business processes and help identify areas that require improvement. Data analytics can help with KPIs in several ways, including identifying relevant KPIs, measuring KPIs accurately, identifying areas for improvement, and forecasting future performance. The revenue cycle integrity process is critical to the financial well-being of a healthcare provider as it ensures they are properly reimbursed for the services they provide while also maintaining patient satisfaction and compliance with regulatory requirements, and that is where integrity becomes important. Overall, data analytics provides organization with valuable insight into their KPIs, enabling them to make informed decision and improve their performance.
Kelly: That sounds very fascinating. Thank you so much for joining us today, Olga, and for sharing this glimpse into your upcoming webinar, The Importance of Data Analytics in Improving Your KPIs, that you’re providing live on May 25th at 1 PM Eastern Time. Thanks again, Olga.
Olga: Thank you, Kelly. I appreciate your time.
Kelly: And thank you all for joining us for this episode of The Hospital Finance Podcast. Until next time…
[music] This concludes today’s episode of the Hospital Finance Podcast. For show notes and additional resources to help you protect and enhance revenue at your hospital, visit besler.com/podcasts. The Hospital Finance Podcast is a production of BESLER | SMART ABOUT REVENUE, TENACIOUS ABOUT RESULTS.
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